TTC is an emotionally charged season. From hormone fluctuations to the desire for a child to the fears and frustrations of unknowns, family planning is anything but easy. It requires enormous investments of time, energy, emotions, and for many, money.
With IVF or egg freezing, the number one concern my patients have is how to ensure that the process will be worth it—the hormones, the injections, the lengthy procedure, and all the emotions that come with it. With starting a family in general, most feel a deep sense of urgency which begs the question of how to make pregnancy happen sooner and reduce the risk of complications or loss. For many women, delayed conception, miscarriage, or failed IVF (or egg retrieval attempts) result from problems with egg quality.
As a refresher from Sex Ed in high school, pregnancy = the implantation of an embryo, and embryos are formed when the sperm meets the egg. Sperm and eggs each contain half a set of DNA, so when the two meet and rendezvous, a person with a ‘complete’ set of DNA is formed. (Way cool!)
Although a woman is born with all the eggs she will ever have, they aren’t all mature. Eggs take about 3 months to mature, with one (typically) achieving full maturity over the course of one menstrual cycle. Of course, this process can be overridden for the purposes of IVF by using medication, and some women may occasionally release more than one mature egg in a given cycle. (If fertilized, this would result in fraternal twins.)
The entire process of egg maturation affects the resultant quality of the egg released in a given cycle (or harvested during an egg retrieval.) This means that each of the 90 days leading up to the egg release/retrieval is important in terms of nutrient quality and availability, exposure to toxins or inflammation, and the delicate balance of hormones that ebbs and flows to bring that egg to maturity. To say that preparation is important for egg quality is an understatement!
One menstrual cycle lasts about one month, but the process of egg development for ovulation or egg retrieval takes upwards of 90 days.Tweet
Many factors contribute to egg quality, such as diet, lifestyle, and more. But today’s post is all about evidence-based supplements (supported by research) that can be used to maximize egg quality, ovulation, and fertility.
If you are trying to conceive, preparing for an egg retrieval for IVF or egg freezing, this post is for you!
Fertility Supplements for Egg Quality
There are many supplements on the market for fertility, but it can be challenging to know what will work and why. For example, some supplements serve as an alternative to fertility drugs, whereas others may serve to help regulate cycles in women who have irregular periods. The majority of the following supplements focus on reducing cellular aging by acting as antioxidants. We are exposed to countless chemicals in our environments and through the natural processes of daily life that produce inflammation, so antioxidant power is everything when it comes to egg quality!
Ubiquinol (not to be confused with ubiquinone) is an antioxidant. This means that it reduces chemical stress in the body and supports mitochondrial function to prevent cell damage. When cells, especially oocytes or eggs, become damaged, it’s more likely that they will die prematurely or multiply into further cells that are not viable. While oxidative stress is a risk factor to all cells, it’s of particular importance with regards to egg quality and fertility.
CoQ10 is also beneficial in egg retrievals in individuals with decreased ovarian reserve. Supplementation with CoQ10 increases the number of healthy eggs that are harvested during a stimulation cycle, and makes it more likely that a healthy egg will be released during a natural cycle.
Ubiquinol is found in foods at very low levels, but these levels are not enough to produce a therapeutic effect. The research shows benefit from 600 mg of ubiquinol taken daily with food leading up to conception.
Note: it is dangerous to suddenly discontinue CoQ10 if it has been used as a supplement for a substantial period of time. If you are planning to discontinue CoQ10, such as in the case that a healthy pregnancy has been established, talk to your doctor about weaning off gradually.
EPA and DHA (Omega 3 Fatty Acids)
EPA and DHA are two key omega-3 fatty acids that are of utmost importance for fertility, egg quality and pregnancy. Research has shown that dietary supplementation with omega-3s improves egg quality, delays ovarian aging, and reducing the risk of birth defects. Studies have shown that an excess of omega-6 fatty acids in comparison to omega 3’s leads to very poor egg quality, so supplementation of EPA and DHA is important for anyone whose diet does not already support healthy fatty acid balance. EPA and DHA are of particular importance for women over age 35 who are trying to conceive because fertility naturally starts to decline after this point.
NAC is a powerful antioxidant. Part of its job is to recycle glutathione, which is part of the body’s natural detoxification system which can be rapidly depleted with illness or use of acetaminophen. Because it is an antioxidant, NAC is important for egg quality, IVF, fertility and pregnancy for many of the same reasons as omega-3 and CoQ10 supplementation, however it accomplishes these outcomes through a different pathway. Like Omega-3s, NAC is safe to take during pregnancy, especially when periods of illness occur. Evidence in research demonstrates that NAC delays aging of eggs and ovaries.
NAD is a naturally occurring coenzyme involved in hundreds of metabolic processes in the body. One of its primary roles is in mitochondrial function, cell regeneration and reduction in oxidative stress. Because mitochondrial function is an essential factor in oocyte (egg) aging and quality, focusing on mitochondrial function is an important consideration for fertility and egg retrieval. Niacin (vitamin B3) is one of the main nutrients involved in regeneration of NAD in the body (also known as NAD+ and NADH), however supplementing with pure niacin can cause a flushing of the skin which is accompanied by intense itching. Nicotinamide is sold as an alternative to niacin without the risk of flushing, however it has the potential to inhibit other enzymes (sirtuins) involved in cellular repair.
One of the most recently discovered types of NAD-boosting vitamins comes from Nicotinamide Riboside, the main ingredient in the supplement “Tru Niagen.” Because supplements can be expensive, you may also consider using a low-dose combination of niacin and nicotinamide in combination with a diet rich in fish, green vegetables and mushrooms which are excellent food sources of vitamin B3.
You may have heard that red wine has antioxidant health benefits. Of course, alcohol is not high on the list of foods to consume when TTC, and the main antioxidant chemical found in red wine, resveratrol, hasn’t been proven for safety in pregnancy either. However, resveratrol’s blueberry-derived cousin Pterostilbene offers the same revolutionary antioxidant benefits as resveratrol itself. Specifically, this chemical increases the expression of proteins called sirtuins which are responsible for cellular repair and anti-aging. When it comes to egg quality, this function is essential which is why pterostilbene proves beneficial.
Pycnogenol is an antioxidant which helps prevent the breakdown of nitrous oxide in the blood stream and at the ovarian level. Nitrous oxide dilates blood vessels, increasing blood flow and oxygen availability to cells. Poor oxygen availability harms cells and leads to cell breakdown whereas relaxed blood vessels, strong blood flow and plenty of oxygen helps prevent oxidative stress, promote cellular repair and prevent egg aging.
Melatonin/Inositol/Alpha Lipoic Acid
In women with PCOS (resulting from elevated androgen levels), the combination of melatonin, inositol and alpha lipoic acid is helpful in reducing testosterone, improving insulin sensitivity and blood sugar control (thereby reducing oxidative stress) and supporting follicle maturity. There is some evidence that melatonin helps improve egg quality regardless of a PCOS diagnosis by forming a barrier between inflammatory chemicals and eggs themselves by accumulating in follicular fluid. However, melatonin should not be used long-term or during pregnancy. Like CoQ10, it’s not a good idea to abruptly discontinue melatonin use; it should be gradually weaned. Other considerations are to ensure that inositol supplements include a 40:1 ratio of myo-inositol and D-chiro inositol (many simply contain myo-inositol). Likewise, alpha-lipoic acid can act as an anti-inflammatory and protectant non-PCOS women against egg damage, oxidative stress, inflammation and neurotoxins both when TTC as well as during pregnancy.
DHEA is unique because although it is not directly an antioxidant chemical, it reverses aging processes in ovaries. However, this hormone should be used with caution, particularly in women who already have elevated levels of DHEA or testosterone, as seen is PCOS. As with other hormones, there are risks both when the level is too low (accelerated ovarian aging) as well as when too high (irregular periods, delayed or absent ovulation, hair loss.) That being said, there is strong evidence that DHEA supplementation can both improve chances of natural pregnancy as well as IVF outcomes, especially in women over age 40.